Evaluation

Changes to Rating Schedule for Chronic Fatigue Sydrome

VA has finalized regulations which change the Rating Schedule relating to Infectious Diseases, Immune Disorders and Nutritional Deficiencies. This schedule includes the rating criteria for Chronic Fatigue Syndrome (CFS).

VA proposed major changes to these diagnostic criteria, to include adding a list of diagnoses (current or past) that would exclude the diagnosis of Chronic Fatigue Syndrome (CFS), including sleep apnea, hypothyroidism, narcolepsy, certain cancers, hepatitis B or C, depression, bipolar disorder, schizophrenia, dementias, and severe obesity (BMI 45 or greater). Fortunately, veterans advocates responded to these proposed regulations, pointing out that VA’s proposals were not in line with current research on CFS. VA chose not to make the majority of the proposed changes, instead opting to convene a working group to discuss changes that will “ensure that the full range of relevant factors is adequately addressed.” The only change that will take effect is the addition of a requirement that a licensed physician prescribe bed rest and treatment to meet the definition of an incapacitating episode. This requirement will be effective August 11, 2019. The rating criteria as of that date will be as follows:

§ 4.88a Chronic fatigue syndrome.

(a) For VA purposes, the diagnosis of chronic fatigue syndrome requires:

(1) new onset of debilitating fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least six months; and

(2) the exclusion, by history, physical examination, and laboratory tests, of all other clinical conditions that may produce similar symptoms; and

(3) six or more of the following:

(i) acute onset of the condition,

(ii) low grade fever,

(iii) nonexudative pharyngitis,

(iv) palpable or tender cervical or axillary lymph nodes,

(v) generalized muscle aches or weakness,

(vi) fatigue lasting 24 hours or longer after exercise,

(vii) headaches (of a type, severity, or pattern that is different from headaches in the pre-morbid state),

(viii) migratory joint pains,

(ix) neuropsychologic symptoms,

(x) sleep disturbance.

6354 Chronic fatigue syndrome (CFS):

Debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, or confusion), or a combination of other signs and symptoms: Which are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care ................…......100

Which are nearly constant and restrict routine daily activities to less than 50 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least six weeks total duration per year .........................................……………………………………………………………………………………………………………... 60

Which are nearly constant and restrict routine daily activities from 50 to 75 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least four but less than six weeks total duration per year ...........……………………………………………………………………………………………………………….. 40

Which are nearly constant and restrict routine daily activities by less than 25 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least two but less than four weeks total duration per year .......………………………………………………………………………………………………………...... 20

Which wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year; or symptoms controlled by continuous medication …………................................... 10

Note: For the purpose of evaluating this disability, incapacitation exists only when a licensed physician prescribes bed rest and treatment.

Why Don't My Service Connected Evaluations Add Up?

When VA grants a claim for service connection, each service-connected disability is assigned a percentage according to VA’s rating schedule. If a veteran is service-connected for multiple disabilities, the combined evaluation determines that rate at which the veteran is paid. Many veterans are surprised that the combined evaluation is not always equal to the sum of the individual evaluations. This is because VA uses the combined ratings table. The premise behind the combined ratings table is that a veteran cannot be more than 100 percent disabled, therefore each additional disability is detracting from the remaining ability rather than simply adding to the disability.

For example, a veteran who is 60 percent disabled is 40 percent not disabled. If that veteran is awarded another 10 percent disability evaluation, then VA will take 10 percent of the remaining 40 percent and consider the veteran 64 percent disabled and 34 percent not disabled. This 64 percent would be rounded down and the veteran would be paid at the 60 percent rate. If a veteran were 60 percent disabled and received an additional 20 percent disability evaluation, VA would consider the veteran 68 percent disabled and 32 percent not disabled. This evaluation would be rounded up to 70 percent. So according to VA math, 60 percent plus 10 percent is 60 percent, while 60 percent plus 20 percent is 70 percent.

The higher the evaluation, the more it takes to get to the next level. For example, if a veteran is service connected at 90 percent, it would take five additional 10 percent disabilities to reach 95 percent disabled, which would round up to a 100 percent evaluation.